- Email: [email protected]
Functional Impairment Due to ADHD From Early Childhood Through Adolesence in a Community Sample of Boys and Girls
Abstracts / Annals of Epidemiology 22 (2012) 661e680
white-NH and black-NH, respectively. Trying to lose weight was reported by 38% of normal, 83% of overweight, and 96% of obese white- NH (p < 0.0001), and 17% of normal, 75% of overweight, and 91% of obese black-NH (p < 0.0001). Of women who are trying to lose weight 41% of white-NH and 38% of black-NH are being physically active while >75% are dieting. Compared to normal weight, overweight and obese white-NH women were 7.0 (95% confidence interval (CI): 4.2, 11.7) and 23.3 (CI: 11.5, 47.0) times as likely to report trying to lose weight while black-NH were 12.3 (CI: 1.6, 96.3), and 15.0 (1.7, 130.3) times as likely to report trying to lose weight, respectively. Conclusion: The majority of overweight/obese women with a history of MI are trying to lose weight; however, methods for weight loss largely include dieting rather than the heart healthy behavior of physical activity. Physical activity may encourage weight loss and healthy perceived BMI.
Reproductive Health and Pediatrics P65-S. Organized Sports Participation in Children With and Without ADHD: the Roles of Self-Perceived Peer Relations and Physical Abilities Jennifer Gander MS, Bo Cai PhD, Steven Cuffe MD, Joseph R. Holbrook PhD, Robert McKeown PhD, FACE. Department of Epidemiology, University of South Carolina, Columbia, SC Purpose: Children with ADHD have motor impairment and poor peer relationships which may lead to decreased participation in organized sports. This study explored direct and indirect effects of ADHD diagnosis and selfconcepts of peer relations and physical abilities on sports participation (SP). Methods: South Carolina Project to Learn about ADHD in Youth data were used to investigate self-perceived peer relations and physical abilities as mediators between ADHD and SP. Children (N¼330) reported their level of organized SP using in a risk behavior survey. Logistic regression and path analysis were utilized to determine significant associations and investigate mediation. Results: Polytomous logistic regression revealed that ADHD diagnosis was related to never (OR¼2.7; 95%CI (1.0, 6.9)) and to low SP (OR¼4.8; 95%CI (1.2, 19.3)). Path analysis revealed an inverse association between peer relations and SP (b¼-0.02 (p-value¼0.04) and a positive association for physical abilities (b¼0.04, p-value<0.001) for a single point change on the Marsh SelfDescription Questionnaire Scales. Conclusion: ADHD diagnosis is related to decreased SP. Selfperceived physical abilities was also significantly related to increased SP. The inverse association between self-perceived peer relations and SP may reflect parental involvement in an effort to enable their children to overcome their social interaction problems or may be the result of our inability to distinguish between organized team and individual sports.
P66. Self-Concept in Children and Adolescents With a Chronic Illness: a Meta-Analysis M.A. Ferro, M.H. Boyle. Department of Psychiatry & Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University Purpose: Using meta-analysis, to compare self-concept (SC) between children with versus without chronic medical illness (healthy children) and to examine methodological influences on effect sizes. Methods: Medline, Embase, and PyschInfo were searched focusing on asthma, cerebral palsy, diabetes, epilepsy, and juvenile arthritis. Inclusion criteria were: 1) original research studies in English; 2) children were <22 years; 3) studies had a child-report of SC; and, 4) data permitted calculation of effect sizes. Study quality was assessed with a modified Quality Index. Effect sizes were calculated as Hedges's g using a random effects model. Results: A total of 63 studies permitted the calculation of 69 effect sizes. Study quality was positively associated with year of publication (p¼0.016). Children with chronic illness had compromised SC, d¼-0.16 (95% CI: -0.25, -0.06). Type of control group was a significant moderator resulting in discrepant findings. Studies based on normative data reported higher SC in
675
children with chronic illness, d¼0.26 (95% CI: 0.09, 0.43), whereas studies that recruited healthy controls reported lower SC in children with chronic illness, d¼-0.24 (95% CI: -0.33, -0.14). Conclusion: Self-concept is compromised in children with chronic illness; however, the effect size may be underestimated because of methodological weaknesses in existing studies. Future research should avoid the use of normative data and employ rigorous methods with respect to representative sampling and control of confounding variables to better appreciate the impact of chronic illness on children's SC.
P67. Latent Class Trajectories of Depression in Mothers of Children With Epilepsy: an Internal Validation Study Using the Bootstrap Procedure M.A. Ferro, K.N. Speechley. Department of Psychiatry & Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University Purpose: The aim of this study was to investigate the robustness of risk factors and latent class trajectories of depressive symptoms among mothers of children with epilepsy using the bootstrapping procedure. Methods: Data were obtained from a multi-centre prospective cohort study (2004-09) of children newly diagnosed with epilepsy and their families in Canada (n¼339). Latent classes of depressive symptom trajectories were modeled using a semi-parametric group-based trajectory modeling approach. Results: Four trajectories were identified: low stable, borderline, moderate increasing, and high decreasing. Goodness of fit, posterior probabilities, and parameter estimates obtained with bootstrapping were not significantly different from the original sample. Calculation of the root mean square error demonstrated minimal non-ignorable bias for three parameter estimates which was subsequently removed with additional sampling. Multinomial logistic regression assessed the robustness of risk factors predicting trajectory group membership. Risk factors identified were identical for the original and bootstrap samples and differences in odds ratios, as calculated with the Method of Variance Estimation Recovery, were not significant. Conclusion: Group-based trajectory modeling combined with bootstrapping offers a robust methodology to uncover potential heterogeneity in populations and identify high-risk individuals.
P68. Functional Impairment Due to ADHD From Early Childhood Through Adolesence in a Community Sample of Boys and Girls J.R. Holbrook, S.P. Cuffe, B. Cai, S.N. Visser, M.S. Forthofer, M. Bottai, R.E. McKeown. Centers for Disease Control and Prevention, Atlanta, GA Purpose: Characterize the breadth, severity, and persistence of ADHD associated functional impairment (FI) from childhood through adolescence. Methods: School-based data were collected on FI due to inattention (IA) and hyperactivity-impulsivity (HI) in six domains of daily life via the Diagnostic Interview Schedule for Children. We interviewed 481 parents (youth aged 513 years), 379 of whom participated in at least one of four follow-ups over the next seven years. Logistic regression of dichotomous FI using all followup data assessed risk of subsequent moderate/severe FI. Results: Getting along with parents was the most common problem due to ADHD. Prevalence of low and moderate IA-associated FI increased through development (mean increase: +7.7% and +4.6%, respectively); low and moderate HI-associated FI decreased (-6.3% and -5.3%). Prevalence of severe IA- and HI-associated FI was consistent through development. Children with severe IA-associated FI at Time 1 were more likely than those with low/ moderate impairment to have IA-associated FI later (F¼4.5, p¼0.03). FI due to HI decreased by age after adjustment for major confounders (OR: 0.87 for each year increase in age, p < 0.001), but FI due to IA remained consistently prevalent (OR: 1.03, p¼0.40). Conclusion: FI due to IA typically persisted through late adolescence while that due to HI often subsided. Clinicians should be aware of these patterns for diagnostic purposes. This information will also help parents and teachers identify and understand problem areas for youth of different ages.
white-NH and black-NH, respectively. Trying to lose weight was reported by 38% of normal, 83% of overweight, and 96% of obese white- NH (p < 0.0001), and 17% of normal, 75% of overweight, and 91% of obese black-NH (p < 0.0001). Of women who are trying to lose weight 41% of white-NH and 38% of black-NH are being physically active while >75% are dieting. Compared to normal weight, overweight and obese white-NH women were 7.0 (95% confidence interval (CI): 4.2, 11.7) and 23.3 (CI: 11.5, 47.0) times as likely to report trying to lose weight while black-NH were 12.3 (CI: 1.6, 96.3), and 15.0 (1.7, 130.3) times as likely to report trying to lose weight, respectively. Conclusion: The majority of overweight/obese women with a history of MI are trying to lose weight; however, methods for weight loss largely include dieting rather than the heart healthy behavior of physical activity. Physical activity may encourage weight loss and healthy perceived BMI.
Reproductive Health and Pediatrics P65-S. Organized Sports Participation in Children With and Without ADHD: the Roles of Self-Perceived Peer Relations and Physical Abilities Jennifer Gander MS, Bo Cai PhD, Steven Cuffe MD, Joseph R. Holbrook PhD, Robert McKeown PhD, FACE. Department of Epidemiology, University of South Carolina, Columbia, SC Purpose: Children with ADHD have motor impairment and poor peer relationships which may lead to decreased participation in organized sports. This study explored direct and indirect effects of ADHD diagnosis and selfconcepts of peer relations and physical abilities on sports participation (SP). Methods: South Carolina Project to Learn about ADHD in Youth data were used to investigate self-perceived peer relations and physical abilities as mediators between ADHD and SP. Children (N¼330) reported their level of organized SP using in a risk behavior survey. Logistic regression and path analysis were utilized to determine significant associations and investigate mediation. Results: Polytomous logistic regression revealed that ADHD diagnosis was related to never (OR¼2.7; 95%CI (1.0, 6.9)) and to low SP (OR¼4.8; 95%CI (1.2, 19.3)). Path analysis revealed an inverse association between peer relations and SP (b¼-0.02 (p-value¼0.04) and a positive association for physical abilities (b¼0.04, p-value<0.001) for a single point change on the Marsh SelfDescription Questionnaire Scales. Conclusion: ADHD diagnosis is related to decreased SP. Selfperceived physical abilities was also significantly related to increased SP. The inverse association between self-perceived peer relations and SP may reflect parental involvement in an effort to enable their children to overcome their social interaction problems or may be the result of our inability to distinguish between organized team and individual sports.
P66. Self-Concept in Children and Adolescents With a Chronic Illness: a Meta-Analysis M.A. Ferro, M.H. Boyle. Department of Psychiatry & Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University Purpose: Using meta-analysis, to compare self-concept (SC) between children with versus without chronic medical illness (healthy children) and to examine methodological influences on effect sizes. Methods: Medline, Embase, and PyschInfo were searched focusing on asthma, cerebral palsy, diabetes, epilepsy, and juvenile arthritis. Inclusion criteria were: 1) original research studies in English; 2) children were <22 years; 3) studies had a child-report of SC; and, 4) data permitted calculation of effect sizes. Study quality was assessed with a modified Quality Index. Effect sizes were calculated as Hedges's g using a random effects model. Results: A total of 63 studies permitted the calculation of 69 effect sizes. Study quality was positively associated with year of publication (p¼0.016). Children with chronic illness had compromised SC, d¼-0.16 (95% CI: -0.25, -0.06). Type of control group was a significant moderator resulting in discrepant findings. Studies based on normative data reported higher SC in
675
children with chronic illness, d¼0.26 (95% CI: 0.09, 0.43), whereas studies that recruited healthy controls reported lower SC in children with chronic illness, d¼-0.24 (95% CI: -0.33, -0.14). Conclusion: Self-concept is compromised in children with chronic illness; however, the effect size may be underestimated because of methodological weaknesses in existing studies. Future research should avoid the use of normative data and employ rigorous methods with respect to representative sampling and control of confounding variables to better appreciate the impact of chronic illness on children's SC.
P67. Latent Class Trajectories of Depression in Mothers of Children With Epilepsy: an Internal Validation Study Using the Bootstrap Procedure M.A. Ferro, K.N. Speechley. Department of Psychiatry & Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University Purpose: The aim of this study was to investigate the robustness of risk factors and latent class trajectories of depressive symptoms among mothers of children with epilepsy using the bootstrapping procedure. Methods: Data were obtained from a multi-centre prospective cohort study (2004-09) of children newly diagnosed with epilepsy and their families in Canada (n¼339). Latent classes of depressive symptom trajectories were modeled using a semi-parametric group-based trajectory modeling approach. Results: Four trajectories were identified: low stable, borderline, moderate increasing, and high decreasing. Goodness of fit, posterior probabilities, and parameter estimates obtained with bootstrapping were not significantly different from the original sample. Calculation of the root mean square error demonstrated minimal non-ignorable bias for three parameter estimates which was subsequently removed with additional sampling. Multinomial logistic regression assessed the robustness of risk factors predicting trajectory group membership. Risk factors identified were identical for the original and bootstrap samples and differences in odds ratios, as calculated with the Method of Variance Estimation Recovery, were not significant. Conclusion: Group-based trajectory modeling combined with bootstrapping offers a robust methodology to uncover potential heterogeneity in populations and identify high-risk individuals.
P68. Functional Impairment Due to ADHD From Early Childhood Through Adolesence in a Community Sample of Boys and Girls J.R. Holbrook, S.P. Cuffe, B. Cai, S.N. Visser, M.S. Forthofer, M. Bottai, R.E. McKeown. Centers for Disease Control and Prevention, Atlanta, GA Purpose: Characterize the breadth, severity, and persistence of ADHD associated functional impairment (FI) from childhood through adolescence. Methods: School-based data were collected on FI due to inattention (IA) and hyperactivity-impulsivity (HI) in six domains of daily life via the Diagnostic Interview Schedule for Children. We interviewed 481 parents (youth aged 513 years), 379 of whom participated in at least one of four follow-ups over the next seven years. Logistic regression of dichotomous FI using all followup data assessed risk of subsequent moderate/severe FI. Results: Getting along with parents was the most common problem due to ADHD. Prevalence of low and moderate IA-associated FI increased through development (mean increase: +7.7% and +4.6%, respectively); low and moderate HI-associated FI decreased (-6.3% and -5.3%). Prevalence of severe IA- and HI-associated FI was consistent through development. Children with severe IA-associated FI at Time 1 were more likely than those with low/ moderate impairment to have IA-associated FI later (F¼4.5, p¼0.03). FI due to HI decreased by age after adjustment for major confounders (OR: 0.87 for each year increase in age, p < 0.001), but FI due to IA remained consistently prevalent (OR: 1.03, p¼0.40). Conclusion: FI due to IA typically persisted through late adolescence while that due to HI often subsided. Clinicians should be aware of these patterns for diagnostic purposes. This information will also help parents and teachers identify and understand problem areas for youth of different ages.